Актуальность. Современные системы визуализации широко применяются в различных областях офтальмологии: диагностике, лазерной хирургии, хирургии катаракты, витреоретинальной хирургии. Высокая информативность, а также высокое качество изображения делают их востребованными в офтальмологической практике. Цель. Оценка современных систем визуализации, применяемых в хирургии глаукомы в Калужском филиале МНТК «Микрохирургия глаза». Материал и методы.Микроинвазивная непроникающая глубокая склерэктомия (МНГСЭ) выполнена 247 пациентам с I–III стадиями первичной открытоугольной глаукомой (ПОУГ). В ходе хирургии использовали систему Ngenuity (Alcon, США) (87 пациентов), микроскоп Hi-R NEO 900A N/R (Haag-Streit Surgical, Германия) с интегрированным iОСТ модулем (74 пациента), комбинированную систему Ngenuity с интегрированным iОСТ модулем (86 пациентов). В ходе МНГСЭ были имплантированы дренажи сетонового типа: Ксенопласт, гидрогелевый, Glautex, «Репер». Результаты. При проведении операций на системе Ngenuity было отмечено высокое качество изображения на экране вне зависимости от степени увеличения изображения, что является значительным преимуществом при проведении обучающего процесса у молодых хирургов. Система позволяет изменять степень интенсивности цветового изображения, что является неоспоримым преимуществом для максимально приближенного к реальному изображению операционного поля. При проведении операций на микроскопе Hi-R NEO 900A N/R с интегрированным iОСТ-модулем отмечается значительное преимущество проведения хирургических операций с онлайн-визуализацией микроструктур глаза. Одномоментный микроуровень контроля проводимой хирургии открывает новые возможности совершенствования хирургической техники. Опция навигации позволяет проводить структурные исследования операционной зоны. Наиболее оптимальной, по нашему мнению, является система, объединившая в себе высокое качество изображения и возможность одномоментного структурного исследования деталей операционной зоны, — система Ngenuity с интегрированной iОСТ. iОСТ-модуль позволяет правильно расположить дренаж (Ксенопласт, гидрогелевый дренаж) в зоне операции и интрасклеральной полости. Отмечено изменение состояния Шлеммова канала при имплантации интраканальной части дренажа «Репер». При имплантации дренажа Glautex отмечена его оптически негативная структура, связанная с химическим составом. Выводы. Современные системы визуализации при МНГСЭ позволяют выйти на новый технический уровень проведения операции. Сочетание высокого качества изображения при максимальном увеличении с одномоментным структурным исследованием является оптимальным условием и требованием к современному подходу в непроникающей хирургии глаукомы.

Purpose. To evaluate the role of intraoperative optical coherence tomography in non-penetrating glaucoma surgery with implantation of various types of drainages. Methods. Non-penetrating deep sclerectomy using seton type drainages (Xenoplast – 67, Hydrogel – 24, Igen – 32, Glautex – 20) was performed in 143 patients with 2–3 stages of glaucoma. The surgery was performed under the control of a Hi-R NEO 900A N / R operating microscope (Haag-Streit Surgical, Germany) with an integrated 3rd generation iOCT optical coherence tomograph. Results. During carrying out microinvasive nonpenetrating deep sclerectomy, intraoperative optical coherence tomography allows monitoring the quality of performed surgical operation in real time at all stages: assessing the thickness of the trabecula, the degree of filtration, the quality of trabeculo-descemet window peeling, the correct positioning of the drainage and the formed filtering bleb. Conclusion. The use of iOCT is a promising and necessary method for introducing into everyday technology of non-penetrating glaucoma surgery. Key words: non-penetrating deep sclerectomy, drainage of the seton type, optical coherence tomograph.

Purpose – to evaluate the effectiveness of surgical treatment of glaucoma in children with implantation of the Ahmed Glaucoma Valve drainage system, depending on the form of the disease. Materials and methods. 124 implantations of the Ahmed Glaucoma Valve FP8 drainage system, model FP8, were performed in the Kaluga branch of the IRTC «Eye Microsurgery» for children with various forms of glaucoma for the period of time from 2010 to 2020. The range of children age was from 0 to 18 years old. Primary implantation was performed in 48 cases. 76 implantations were performed after previous glaucoma interventions. 23 patients were operated on in both eyes. The operation was performed with organ-preserving purpose for 26 patients at different ages. Implantation was performed for the eyes with low visual capabilities (below 0.06) in 34 cases. Results. It was noted to decrease in the level of IOP in various types of glaucoma in children in the early postoperative period, in 100% of cases. The level of IOP remained within the normal range in 68% of cases in terms of up to 1 year. The reasons of the increase in the level of ophthalmotonus were associated with the formation of a fibrous capsule above the drainage body and a disturbance in the flow of intraocular fluid in 32% of cases. An increase of IOP was noted up to 3 years in fifty per cent of cases. IOP was regulated by the appointment of antihypertensive medicine in the eyes, where the increase of IOP was not accompanied by significant visual signs of the formation of a fibrous filter pad. Otherwise, the inspection zone of the filtration pad was conducted an audit with excision of the fibrous tissue forming above the drainage body area. As a result, the level of IOP has reached normal values. Conclusion. Along with traditional treatment methods, operations using the Ahmed drainage system are promising in the treatment of childhood glaucoma. In case of some types of congenital glaucoma, they may be the operations of the first choice (in the associated and all secondary types of glaucoma). Undoubtedly, this type of surgery requires further improvements. Including the development of materials to cover the drainage system, which will interfere with severe scarring processes.

Glaucoma is one of the main diseases leading to visual impairment and blindness. At present, drainage device surgery is the most effective way to normalize the intraocular pressure and preserve visual functions. Depending on the material, the following types of drainage devices are distinguished: collagen-based; metal-based; synthetic polymerbased and biopolymer-based. This paper described the main characteristics of these types of drainage devices and provides data on their use in clinical ophthalmic practice. Data analysis led us to believe that due to the imperfection of the materials a dense connective tissue capsule forms around the implant, obliterating the newly created outflow pathways of the intraocular fluid. A wide selection of drainage devices existing at present indicates the absence of material around which scar tissue would not form. At present synthetic drainage device from natural polymers shows optimal properties. They combine the advantages of all groups: greater resistance compared to natural polymers, high biocompatibility, physiological transport of intraocular fluid. However, they do not yet answer all the necessary criteria, requiring further scientific research in this direction.

PURPOSE: To evaluate the safety criteria of femtolaser impact during femtosecond laser–assisted cataract phacoemulsification on the filtration zone after microinvasive non-penetrating deep sclerotomy based on ultrasound bio- microscopy data. MATERIALS AND METHODS: 12 patients (15 eyes) with operated primary open-angle glaucoma, 7 women and 5 men, were kept under observation. The average age of the patients was 64±11 years. Femtosecond laser–assisted cataract phacoemulsification was performed 6-12 months after microinvasive non-penetrating deep sclerectomy. In addition to standard research methods all patients underwent ultrasound biomicroscopy prior to surgery. The femtolaser stage of the surgery was performed using FEMTO LDV Z8 device («Ziemer», Switzerland). Ultrasonic cataract phacoemulsification was performed using Centurion VisionSystem («Alcon», USA) according to the standard phaco-chop technique. Ultrasonic biomicroscopy follow-up was performed 1 day and 1 month after the operation. RESULTS: Study results indicate the need to include ultrasound biomicroscopy into the list of mandatory diag nostic research methods for patients with previously operated glaucoma prior to femtosecond laser–assisted cataract surgery. To ensure a safe performing of femtolaser cataract surgery in patients after microinvasive non-penetrating deep sclerectomy, one has to take into account a combination of such features as the preservation of the linear profile of the trabeculodecemetic membrane, the absence of its dense adhesions with surrounding tissues, and the presence of an intrascleral cavity with a height of 0.25 mm and above. Failure to respect these conditions when using femtosecond laser technology can lead to adverse changes of the newly formed drainage system. CONCLUSION: Femtosecond laser–assisted cataract surgery for patients who previously underwent microinvasive non-penetrating deep sclerotomy (MNSE) is a safe and effective technology when performed after a preliminary selection of patients based on filtration zone ultrasound biomicroscopy (UBM).

The article presents a clinical case of fungal endophthalmitis, the causative agent of which was Paecilomyces lilacinum. Patient M., female, 1947 year of birth was operated on for complicated cataract of the right eye. Two weeks later, she complained of decreased vision. A local anti-inflammatory therapy of the exudative reaction in the anterior chamber was carried out, therefore an improvement was achieved. Two weeks later, the patient again complained of visual impairment. Лечение было продолжено со сменой фунгицидных средств, обладающих большим Systemic and local anti-inflammatory and antibacterial therapy of exudative uveitis with the course of fluconazole for 15 days was carried out. Extended clinical and laboratory studies did not reveal any chronic inflammatory and immune diseases in the female patient. In connection with the further progression of the process, vitrectomy was performed with the removal of IOL and washing of the vitreous cavity with a solution of vancomycin. The achieved stabilization lasted short. There were appeared signs indicating a fungal etiology of the inflammatory process. Taking into account the previous long-term antibiotic therapy, yeast contamination was suggested. Despite the active treatment, there was a further deterioration of the eye. No pathogenic and conditionally pathogenic microflora growth was revealed as a result of seeding. Confocal microscopy revealed a filamentous structure of the mycelium in the thickness of the corneal stroma, which indicated infection with mold, not yeast fungi. Treatment was continued with a change of fungicidal agents with a large spectrum of action, as well as a silicone oil tamponade. The obtained culture was aimed at identification of the species and determination of sensitivity to fungicides in the medical scientific and practical center for tuberculosis control, Moscow. Cultural studies identified pathogenic microflora – Paecilomyces lilacinum, sensitive to ketoconazole. In connection with the spread of infection to the periorbital tissues, with the subsequent probability of systemic damage, an emergency enucleation of the eyeball was decided. This example indicates the need for increased alertness for fungal infection in cases of atypical flow of intraocular inflammation, the search for methods for early detection of the pathogen.

Purpose. To perform a comparative evaluation of dynamics of changes in the natural and surgically formed outflow pathways of aqueous humor using optical coherence tomography (OCT) in patients after canaloplasty and non-penetrating deep sclerectomy (NPDS).Material and methods. The study included 41 patients (66 eyes) with primary open-angle glaucoma of 1-3 stages after the performed surgical intervention. All patients were divided into 2 groups: canaloplasty using the micro-catheter with a 150µm diameter was carried out in 18 patients (32 eyes) in the group 1 and the NPDS without any devices – in 23 patients (34 eyes) in the group 2. All patients underwent standard ophthalmic examinations and the optical coherence tomography of the surgical area was performed on the first day, 1 week, 1 month, 3 months, 6 months, 9 months, 12 months postoperatively. Following features were evaluated: the presence of the filtering bleb and its height, scleral flap thickness, parameters of intra-scleral cavity, presence of inclusions, trabeculodescemet membrane (TDM) size, a hypo-echogenic tunnel behind the scleral flap.Results. Starting from the early postoperative period (up to 7 days) the surgical zone had pronounced differences between the groups. In the main group the filtering bleb height was 0.56±0.16mm while in the control group – 0.98±0.1mm. The initial intra-scleral cavity height was less in the canaloplasty group than in the NPDS group (0.33±0.16mm and 0.59±0.1mm, respectively). The thickness of the scleral flap in the main and control groups was 0.25±0.03 and 0.27±0.03mm, respectively. The average TDM thickness at the baseline was in both groups 0.08±0.002mm.In the long-term period linear dimensions of the investigated parameters of drainage system decreased on the background progressive increase of the optical density of the structures. In the main group 6-12 months after the performed canaloplasty the conjunctiva had practically an intact appearance. Besides, in the group 1 the scleral flap thickness was decreased up to the disappearance the intra-scleral space parameters decreased significantly (0.06±0.025×1.9±0.2×0.42±0.26mm) up to a complete overgrowing. In the control group the filtering bleb height (up to 0.73±0.1mm), the scleral flap thickness (up to 0.12±0.013mm), intrascleral space parameters (up to 0.22±0.12×2.3±0.12×1.7±0.9mm), the hypo-echogenic tunnel behind the scleral flap were decreased. An IOP reduction was detected compared with preoperative levels in all patients. Mean IOP in the canaloplasty group was 21.1±2.1mmHg at 12 months, in the control group – 20.6±2.8mmHg, respectively.Conclusions. The performed comparative analysis revealed a close relationship between structural changes in the area of glaucoma surgery and IOP indices in both groups (a negative correlation of IOP values with the bleb filtering height, scleral flap thickness, height, width and length of the intra-scleral cavity, and a thickness of the trabeculodescemet membrane in the main group, p<0.05). Optical coherence tomography was used to evaluate parameters of the surgical zones after canaloplasty and NPDS.

Purpose. To carry out a comparative evaluation of clinical and functional results of non-penetrating deep sclerectomy and canaloplasty in patients with primary open-angle glaucoma within the 12 month follow-up. Material and methods. The study included 93 patients (151 eyes) with non-compensated primary open-angle glaucoma (POAG) (67 female and 26 male), the mean age 66.5±10.8 years, who were divided into 2 groups: the main group consisted of 51 patients (84 eyes) where was scheduled the canaloplasty and in the control group of 42 patients (67 eyes) the non-penetrating deep sclerectomy (NPDS) was scheduled. Each group was additionally divided into 2 subgroups according to POAG stages (initial and advanced B – far-advanced). The follow-up was 12 months. Results . The successful micro-catheter implantation into the lumen of Schlemm’s canal was achieved in 63 cases (75%). In the early postoperative period, the most frequent complications in the group 1 were micro-hyphema and hyphema in 49 cases (77.7%) and elevated intraocular pressure was in 16 cases (25.4%). In the second group the most frequent complications were choroid detachment in 14 cases (20.9%) and elevated intraocular  pressure in 8 cases (11.9%). In the late postoperative period, the elevated intraocular pressure (IOP) was the most common complication in all groups: 27 cases (42.8%) in the group 1 and 17 cases (25.4%) in the group 2. At 12 months the mean IOP was 21.9±4.2mmHg in the group 1 and 20.6±2.85mmHg in the group 2, respectively. The quantity of glaucoma medications by the end of follow-up in the group 1 decreased on average from 1.8±0.8 to 1.3±0.8; in the second group the IOP decreased from 1.9±0.65  to 0.7±0.65, respectively. Conclusions. Canaloplasty and non-penetrating deep sclerectomy are safe and effective in the surgical management of open-angle glaucoma. Canaloplasty procedures showed comparable efficacy to non-penetrating deep sclerectomy in the IOP reduction in patients with initial and advanced stages of glaucoma.

Purpose. To carry out a comparative evaluation of clinical and functional results of non-penetrating deep sclerectomy and canaloplasty in patients with primary open-angle glaucoma within the 12 month follow-up.Material and methods. The study included 93 patients (151 eyes) with non-compensated primary open-angle glaucoma (POAG) (67 female and 26 male), the mean age 66.5±10.8 years, who were divided into 2 groups: the main group consisted of 51 patients (84 eyes) where was scheduled the canaloplasty and in the control group of 42 patients (67 eyes) the non-penetrating deep sclerectomy (NPDS) was scheduled. Each group was additionally divided into 2 subgroups according to POAG stages (initial and advanced B – far-advanced). The follow-up was 12 months. Results. The successful micro-catheter implantation into the lumen of Schlemm’s canal was achieved in 63 cases (75%). In the early postoperative period, the most frequent complications in the group 1 were micro-hyphema and hyphema in 49 cases (77.7%) and elevated intraocular pressure was in 16 cases (25.4%). In the second group the most frequent complications were choroid detachment in 14 cases (20.9%) and elevated intraocular pressure in 8 cases (11.9%). In the late postoperative period, the elevated intraocular pressure (IOP) was the most common complication in all groups: 27 cases (42.8%) in the group 1 and 17 cases (25.4%) in the group 2. At 12 months the mean IOP was 21.9±4.2mmHg in the group 1 and 20.6±2.85mmHg in the group 2, respectively. The quantity of glaucoma medications by the end of follow-up in the group 1 decreased on average from 1.8±0.8 to 1.3±0.8; in the second group the IOP decreased from 1.9±0.65 to 0.7±0.65, respectively.Conclusions. Canaloplasty and non-penetrating deep sclerectomy are safe and effective in the surgical management of open-angle glaucoma. Canaloplasty procedures showed comparable efficacy to non-penetrating deep sclerectomy in the IOP reduction in patients with initial and advanced stages of glaucoma.

The article presents a clinical case of patient G., born in 1936, diagnosed with congenital aniridia OU. Terminal glaucoma IV C PT, Mature cataract OD. Secondary glaucoma III C, almost Mature cataract OS.The patient with a severe primary disease congenital aniridia preserved visual function even at advanced age, while typically such patients have a much worse vision due to numerous complications. The disease proceeded relatively favorably, given that a significant reduction of visual acuity occurred at the old age.

Epidemiological data, classification, and forms of congenital glaucoma are presented. The main treatment methods for refractory glaucoma in children are analyzed. A clinical experience of drainage system Ahmed Glauсoma Valve implantation at glaucoma surgery in children is presented. Advantages and disadvantages of the system are shown. Technical peculiarities and operational and postoperational complications of the drainage surgery with use of drainage system Ahmed Glauсoma Valve are demonstrated.